{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T23:55:26Z","timestamp":1792108526941,"version":"4.4.0"},"reference-count":49,"publisher":"BMJ","issue":"10","license":[{"start":{"date-parts":[[2024,10,14]],"date-time":"2024-10-14T00:00:00Z","timestamp":1728864000000},"content-version":"unspecified","delay-in-days":13,"URL":"https:\/\/creativecommons.org\/licenses\/by\/3.0\/igo\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,9,16]]},"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>There are limited global data on ectopic pregnancy (EP) and molar pregnancy (MP), making it important to understand their epidemiology and management across different regions. Our study aimed to describe their prevalence for both conditions, severity of their complications and management among women in selected health facilities across 17 countries in Africa and Latin America and the Caribbean (LAC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This is a secondary analysis of the WHO multi-country survey on abortion. Data were collected from 280 healthcare facilities across 11 countries in Africa and 6 in LAC. Sociodemographic information, signs and symptoms, management and clinical outcomes were extracted from medical records. Facility-level data on post-abortion care (PAC) capabilities were also collected, and facilities were classified accordingly. \u03c7\n                      <jats:sup>2<\/jats:sup>\n                      or Fisher\u2019s exact tests were used to compare categorical data.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The total number of women with EP and MP across both regions was 9.9% (2 415\/24 424) where EP accounted for 7.8% (1 904\/24 424) and MP for 2.1% (511\/24 424). EP presented a higher severity of complications than MP. At admission, 49.8% of EP had signs of peritoneal irritation. The most common surgical management for EP was laparotomy (87.2%) and for MP, uterine evacuation (89.8%). Facilities with higher scores in infrastructure and capability to provide PAC more frequently provided minimal invasive management using methotrexate\/other medical treatment (34.9%) and laparoscopy (5.1%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In Africa and LAC, EP and MP cause significant maternal morbidity and mortality. The disparity in the provision of good quality care highlights the need to strengthen the implementation of evidence-based recommendations in the clinical and surgical management of EP and MP.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-086723","type":"journal-article","created":{"date-parts":[[2024,10,14]],"date-time":"2024-10-14T22:45:22Z","timestamp":1728945922000},"page":"e086723","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Prevalence and management of ectopic and molar pregnancies in 17 countries in Africa and Latin America and the Caribbean: a secondary analysis of the WHO multi-country cross-sectional survey on abortion"],"prefix":"10.1136","volume":"14","author":[{"given":"Camila Ayume Amano","family":"Cavalari","sequence":"first","affiliation":[{"name":"Departamento de Tocoginecologia, Universidade Estadual de Campinas Faculdade de Ciencias Medicas, Campinas, Sao Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4991-616X","authenticated-orcid":false,"given":"Hedieh","family":"Mehrtash","sequence":"additional","affiliation":[{"name":"UNDP\/UNFPA\/UNICEF\/WHO\/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneve, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4860-0828","authenticated-orcid":false,"given":"Vanessa","family":"Brizuela","sequence":"additional","affiliation":[{"name":"UNDP\/UNFPA\/UNICEF\/WHO\/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneve, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1016-4896","authenticated-orcid":false,"given":"Adama","family":"Baguiya","sequence":"additional","affiliation":[{"name":"Kaya Health and Demographic Surveillance System (Kaya-HDSS), Ouagadougou, Burkina Faso"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kwame","family":"Adu-Bonsaffoh","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, Accra, Greater Accra, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1285-8445","authenticated-orcid":false,"given":"Jose Guilherme","family":"Cecatti","sequence":"additional","affiliation":[{"name":"Departamento de Tocoginecologia, Universidade Estadual de Campinas Faculdade de Ciencias Medicas, Campinas, Sao Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis","family":"Bahamondes","sequence":"additional","affiliation":[{"name":"Departamento de Tocoginecologia, Universidade Estadual de Campinas Faculdade de Ciencias Medicas, Campinas, Sao Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7133-0574","authenticated-orcid":false,"given":"Charles M'poca","family":"Charles","sequence":"additional","affiliation":[{"name":"Departamento de Tocoginecologia, Universidade Estadual de Campinas Faculdade de Ciencias Medicas, Campinas, Sao Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip","family":"Govule","sequence":"additional","affiliation":[{"name":"Epidemiology and Disease Control, University of Ghana College of Health Sciences, Accra, Greater Accra, Ghana"},{"name":"Health Sciences, Uganda Martyrs University Faculty of Health Sciences, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Paul","family":"Dossou","sequence":"additional","affiliation":[{"name":"CNHU-HKM Centre de Recherche en Reproduction Humaine et en D\u00e9mographie, Cotonou, Benin"},{"name":"Public Health, Instituut voor Tropische Geneeskunde, Antwerpen, Flanders, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renato T","family":"Souza","sequence":"additional","affiliation":[{"name":"Departamento de Tocoginecologia, Universidade Estadual de Campinas Faculdade de Ciencias Medicas, Campinas, Sao Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis Henrique","family":"Le\u00e3o","sequence":"additional","affiliation":[{"name":"Departamento de Tocoginecologia, Universidade Estadual de Campinas Faculdade de Ciencias Medicas, Campinas, Sao Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronique","family":"Filippi","sequence":"additional","affiliation":[{"name":"London School of Hygiene & Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00d6zge","family":"Tun\u00e7alp","sequence":"additional","affiliation":[{"name":"UNDP\/UNFPA\/UNICEF\/WHO\/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneve, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8837-8061","authenticated-orcid":false,"given":"Luiz Francisco","family":"Baccaro","sequence":"additional","affiliation":[{"name":"Departamento de Tocoginecologia, Universidade Estadual de Campinas Faculdade de Ciencias Medicas, Campinas, Sao Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,10,14]]},"reference":[{"key":"2025121222095413000_14.10.e086723.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(05)67103-6"},{"key":"2025121222095413000_14.10.e086723.2","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0291316","article-title":"Global burden and trends of ectopic pregnancy: an observational trend study from 1990 to 2019","volume":"18","author":"Zhang","year":"2023","journal-title":"PLoS ONE"},{"key":"2025121222095413000_14.10.e086723.3","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-023-16663-y","article-title":"Global burden of pelvic inflammatory disease and ectopic pregnancy from 1990 to 2019","volume":"23","author":"He","year":"2023","journal-title":"BMC Public Health"},{"key":"2025121222095413000_14.10.e086723.4","doi-asserted-by":"publisher","DOI":"10.3109\/00016349.2010.486825"},{"key":"2025121222095413000_14.10.e086723.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2006.11.005"},{"key":"2025121222095413000_14.10.e086723.6","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e31817d201e"},{"key":"2025121222095413000_14.10.e086723.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2013.06.013"},{"key":"2025121222095413000_14.10.e086723.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2011.12.021"},{"key":"2025121222095413000_14.10.e086723.9","article-title":"Awareness about a life-threatening condition: ectopic pregnancy in a network for surveillance of severe maternal morbidity in Brazil","volume":"2014","author":"Rocha Filho","year":"2014","journal-title":"Biomed Res Int"},{"key":"2025121222095413000_14.10.e086723.10","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3182113c10"},{"key":"2025121222095413000_14.10.e086723.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2012.09.040"},{"key":"2025121222095413000_14.10.e086723.12","doi-asserted-by":"publisher","DOI":"10.1097\/GRF.0b013e3182516d7b"},{"key":"2025121222095413000_14.10.e086723.13","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.1987.tb02311.x"},{"key":"2025121222095413000_14.10.e086723.14","first-page":"155","article-title":"Advances in the epidemiology of gestational trophoblastic disease","volume":"39","author":"Palmer","year":"1994","journal-title":"J Reprod Med"},{"key":"2025121222095413000_14.10.e086723.15","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(03)01245-2"},{"key":"2025121222095413000_14.10.e086723.16","doi-asserted-by":"crossref","DOI":"10.1136\/bmjmed-2022-000321","article-title":"Advances in the diagnosis and early management of gestational trophoblastic disease","volume":"1","author":"Joyce","year":"2022","journal-title":"BMJ Med"},{"key":"2025121222095413000_14.10.e086723.17","first-page":"629","article-title":"Changes of clinical features in hydatidiform mole: analysis of 113 cases","volume":"53","author":"Hou","year":"2008","journal-title":"J Reprod Med"},{"key":"2025121222095413000_14.10.e086723.18","doi-asserted-by":"publisher","DOI":"10.1097\/IGC.0000000000000682"},{"key":"2025121222095413000_14.10.e086723.19","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2016-000113","article-title":"WHO Multi-Country Survey on Abortion-related Morbidity and Mortality in Health Facilities: study protocol","volume":"1","author":"Kim","year":"2016","journal-title":"BMJ Glob Health"},{"key":"2025121222095413000_14.10.e086723.20","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2020-003702","article-title":"Understanding abortion-related complications in health facilities: results from WHO multicountry survey on abortion (MCS-A) across 11 sub-Saharan African countries","volume":"6","author":"Qureshi","year":"2021","journal-title":"BMJ Glob Health"},{"key":"2025121222095413000_14.10.e086723.21","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2021-005618","article-title":"Abortion-related morbidity in six Latin American and Caribbean countries: findings of the WHO\/HRP multi-country survey on abortion (MCS-A)","volume":"6","author":"Romero","year":"2021","journal-title":"BMJ Glob Health"},{"key":"2025121222095413000_14.10.e086723.22","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.09.071001"},{"key":"2025121222095413000_14.10.e086723.23","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1002\/ijgo.14056","article-title":"Health facilities\u2019 capability to provide comprehensive postabortion care in Sub\u2010Saharan Africa: Evidence from a cross\u2010sectional survey across 210 high\u2010volume facilities","volume":"156","author":"Compaor\u00e9","year":"2022","journal-title":"Intl J Gynecology & Obste"},{"key":"2025121222095413000_14.10.e086723.24","doi-asserted-by":"crossref","DOI":"10.1186\/s12884-021-03618-7","article-title":"Determinants of ectopic pregnancy among pregnant women attending referral hospitals in southwestern part of Oromia regional state, Southwest Ethiopia: a multi-center case control study","volume":"21","author":"Gerema","year":"2021","journal-title":"BMC Pregnancy Childbirth"},{"key":"2025121222095413000_14.10.e086723.25","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0207699","article-title":"Risk factors for ectopic pregnancy in a population of Cameroonian women: a case-control study","volume":"13","author":"Assouni Mindjah","year":"2018","journal-title":"PLoS One"},{"key":"2025121222095413000_14.10.e086723.26","doi-asserted-by":"crossref","first-page":"95","DOI":"10.11604\/pamj-cm.2020.2.95.21279","article-title":"Incidence, risk factors, clinical presentation and treatment of ectopic pregnancy in the Limbe and Buea Regional Hospitals in Cameroon","volume":"2","author":"Njingu","year":"2020","journal-title":"PAMJ Clin Med"},{"key":"2025121222095413000_14.10.e086723.27","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.4103\/njcp.njcp_172_23","article-title":"The feasibility of introducing early pregnancy assessment unit in Nigerian hospitals: a pilot study from a private hospital in Enugu, Southeast Nigeria","volume":"26","author":"Ugwu","year":"2023","journal-title":"Niger J Clin Pract"},{"key":"2025121222095413000_14.10.e086723.28","doi-asserted-by":"crossref","DOI":"10.1186\/s12884-022-05269-8","article-title":"Ectopic pregnancy in China during 2011-2020: a single-centre retrospective study of 9499 cases","volume":"22","author":"Xu","year":"2022","journal-title":"BMC Pregnancy Childbirth"},{"key":"2025121222095413000_14.10.e086723.29","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-0412.2003.00175.x"},{"key":"2025121222095413000_14.10.e086723.30","doi-asserted-by":"crossref","first-page":"515","DOI":"10.2147\/IJWH.S49672","article-title":"Ectopic pregnancy: a life-threatening gynecological emergency","volume":"5","author":"Lawani","year":"2013","journal-title":"Int J Womens Health"},{"key":"2025121222095413000_14.10.e086723.31","doi-asserted-by":"crossref","first-page":"177","DOI":"10.4103\/npmj.npmj_35_20","article-title":"Ectopic pregnancy at the Lagos University Teaching Hospital, Lagos, South-Western Nigeria: Temporal trends, clinical presentation and management outcomes from 2005 to 2014","volume":"27","author":"Olamijulo","year":"2020","journal-title":"Niger Postgrad Med J"},{"key":"2025121222095413000_14.10.e086723.32","doi-asserted-by":"crossref","DOI":"10.1155\/2022\/1491419","article-title":"Factors Associated with Ruptured Ectopic Pregnancy: A 10-Year Review at a District Hospital in Ghana","volume":"2022","author":"Sefogah","year":"2022","journal-title":"Obstet Gynecol Int"},{"key":"2025121222095413000_14.10.e086723.33","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2393-13-86","article-title":"The impact of tubal ectopic pregnancy in Papua New Guinea--a retrospective case review","volume":"13","author":"Hamura","year":"2013","journal-title":"BMC Pregnancy Childbirth"},{"key":"2025121222095413000_14.10.e086723.34","first-page":"235","article-title":"Hydatidiform mole and its complications: review of patient profiles and management at the university of the Philippines-Philippine General Hospital","volume":"59","author":"Cagayan","year":"2014","journal-title":"J Reprod Med"},{"key":"2025121222095413000_14.10.e086723.35","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9378(00)70324-3"},{"key":"2025121222095413000_14.10.e086723.36","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/dev332"},{"key":"2025121222095413000_14.10.e086723.37","article-title":"Interventions for tubal ectopic pregnancy","volume":"2007","author":"Hajenius","year":"2007","journal-title":"Cochrane Database Syst Rev"},{"key":"2025121222095413000_14.10.e086723.38","doi-asserted-by":"crossref","first-page":"848","DOI":"10.3346\/jkms.2004.19.6.848","article-title":"Clinical outcomes of patients treated for cervical pregnancy with or without methotrexate","volume":"19","author":"Kim","year":"2004","journal-title":"J Korean Med Sci"},{"key":"2025121222095413000_14.10.e086723.39","doi-asserted-by":"publisher","DOI":"10.1002\/uog.56"},{"key":"2025121222095413000_14.10.e086723.40","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1111\/jog.13318","article-title":"Cook Cervical Ripening Balloon successfully prevents excessive hemorrhage combined with ultrasound-guided suction curettage in the treatment of cesarean scar pregnancy","volume":"43","author":"Wu","year":"2017","journal-title":"J Obstet Gynaecol Res"},{"key":"2025121222095413000_14.10.e086723.41","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002560"},{"key":"2025121222095413000_14.10.e086723.42","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1002\/ijgo.12615","article-title":"Update on the diagnosis and management of gestational trophoblastic disease","volume":"143 Suppl 2","author":"Ngan","year":"2018","journal-title":"Int J Gynaecol Obstet"},{"key":"2025121222095413000_14.10.e086723.43","first-page":"e1","article-title":"Management of gestational trophoblastic disease","volume":"128","year":"2021","journal-title":"BJOG"},{"key":"2025121222095413000_14.10.e086723.44","doi-asserted-by":"publisher","DOI":"10.1006\/gyno.2000.5839"},{"key":"2025121222095413000_14.10.e086723.45","unstructured":"World Health Organization . Health worker roles in providing safe abortion care and post-abortion contraception. Geneva, Switzerland: World Health Organization, 2015."},{"key":"2025121222095413000_14.10.e086723.46","doi-asserted-by":"publisher","DOI":"10.1097\/OGX.0b013e31829cdbeb"},{"key":"2025121222095413000_14.10.e086723.47","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9378(99)70665-4"},{"key":"2025121222095413000_14.10.e086723.48","doi-asserted-by":"crossref","DOI":"10.1155\/2021\/4443117","article-title":"Ectopic Pregnancy in Tigray, Ethiopia: A Cross-Sectional Survey of Prevalence, Management Outcomes, and Associated Factors","volume":"2021","author":"Berhe","year":"2021","journal-title":"J Pregnancy"},{"key":"2025121222095413000_14.10.e086723.49","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1055\/s-0043-1768999","article-title":"Changing Paradigms in the Initial Treatment of Ectopic Pregnancy at a University Hospital in Brazil","volume":"45","author":"Tavares","year":"2023","journal-title":"Rev Bras Ginecol Obstet"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2024-086723","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T06:10:09Z","timestamp":1765606209000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2024-086723"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10]]},"references-count":49,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2024,10,14]]},"published-print":{"date-parts":[[2024,10]]}},"alternative-id":["10.1136\/bmjopen-2024-086723"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2024-086723","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10]]}}}